P1357 - New Onset Autoimmune Hepatitis in a First Trimester Multigravida

Michael DeMarco, DO¹, Veena Madhu, MD¹, Hiba Hameed Chagla, MD¹, Anila Vasireddy, MD², Ali Ismail, MD^1
1Penn Medicine, Philadelphia, PA; ²University of Pennsylvania Health System, Philadelphia, PA

Introduction: Autoimmune hepatitis (AIH) presenting as the primary liver disorder in the first trimester of pregnancy is an exceedingly rare clinical entity, posing unique challenges in diagnosis and management. Here we discuss a case of a 22-year-old female G3P1 who presented with nonspecific symptoms of multifocal intermittent back pain and diffuse abdominal pain at 6 weeks gestation.

Case Description/Methods: Initial laboratory investigations revealed elevated liver chemistries and immunoglobulin G levels, prompting further evaluation. Serological markers for viral hepatitis and metabolic liver diseases were negative, while autoimmune markers, including antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), were markedly elevated. A liver biopsy was deferred after thorough risk versus benefit discussions with the patient and consulting teams. The patient was started on prednisone therapy after a multidisciplinary consultation involving hepatologists and obstetricians to balance the risks and benefits to both the patient and the fetus. She responded favorably with improving liver enzymes to near normal levels and improving symptoms. Close monitoring of liver function tests and fetal well-being has been conducted throughout pregnancy. The patient has not yet reached full term, but fetal health has remained uncompromised so far. As her pregnancy progresses, plans are in place to transition to azathioprine while tapering off prednisone.

Discussion: This case represents a rare instance of AIH as a primary presentation in early pregnancy and highlights the importance of a systematic approach to diagnosis and management involving a multidisciplinary team. Further studies are warranted to delineate optimal treatment strategies and outcomes in similar clinical scenarios. AI was used to plan and structure a first draft of this abstract. All substantive details were added by the primary author after the fact.


Disclosures:


Michael DeMarco, DO¹, Veena Madhu, MD¹, Hiba Hameed Chagla, MD¹, Anila Vasireddy, MD², Ali Ismail, MD¹. P1357 - New Onset Autoimmune Hepatitis in a First Trimester Multigravida, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.